When President Joe Biden announced sweeping vaccine mandates last month, plenty of questions arose over whether they could be properly implemented and whether they’d work — or if they would prompt an exodus of vaccine-hesitant employees.
Weeks later, it’s clear that the mandates have had their intended effect. States like California and New York, which have implemented mandates for healthcare employees, have already seen an increase in vaccinations.
This shouldn’t be a surprise, given past precedent. Healthcare providers have historically required their employees be vaccinated against other diseases to prevent them from spreading in clinical settings. What’s new this time around is the spread of mandates across other sectors and industries.
“We know vaccine mandates work,” said L.J. Tan, chief strategy officer at the Immunization Action Coalition. “What we’re seeing with COVID-19 is that more of the non-healthcare sectors are beginning to implement them. It’s clearly important for the private sector in moving the economy forward and in terms of getting employees and services back. These mandates are making a difference.”
When New York state’s vaccine mandate went into effect September 27, inoculations jumped. As of September 28, 87% of hospital staff were vaccinated, compared to 77% just four days earlier.
Meanwhile, this week New York City Mayor Bill de Blasio announced that 95% of Education Department employees were vaccinated. And almost all of United Airlines’ 67,000 U.S. workers have been inoculated in the wake of the company’s announcement mandating the shot.
While there were some initial concerns that vaccine-hesitant employees would simply quit their jobs – and find new ones easily, given the demand for workers – those worries proved overstated. That’s largely because many unvaccinated Americans aren’t necessarily stalwart anti-vaxxers. Rather, they fall into the category of wait-and-see.
“There’s a healthy percentage that are on the fence, and I don’t think we’re seeing that population of people quit their jobs,” Tan said.
At the same time, Tan anticipates “more pushback – private lawsuits and things like that. But there’s enough legal precedent out there that says private sector companies have the authority to make [vaccination] a condition of employment.”
In fact, mandates may well be the most effective tool for triggering action among the wait-and-see population. When given a binary choice between getting vaccinated or getting fired, many people will choose the former option.
“Lots of individuals are not implacably opposed to COVID-19 vaccines. When there is a job-related rationale for getting vaccinated, they are willing to do so,” said Dr. Sten Vermund, dean of the Yale School of Public Health. “A large majority of Americans are fully aware that control of infectious diseases often involves an action of an individual to try to protect a community – just as a red traffic light inhibits individual liberty, but enhances community safety.”
Reaching strident anti-vaxxers, however, is a different problem entirely and one that isn’t likely to be resolved with mandates.
“It’s not a matter of compliance with them; it’s a fundamental mistrust of vaccines,” Tan explained. “People in that group tend to never fundamentally change their minds. The juice is not worth the squeeze.”
That’s why the focus should remain on the wait-and-see contingent as well as younger people who have expressed some hesitation. For those populations, an ideal combination might be mandates paired with outreach emphasizing that vaccination can restore their ability to safely engage in a range of activities.
Some smaller details still need to be ironed out. There is, of course, the challenge of people securing fake vaccination cards to evade mandates. The bigger question is whether the U.S. will follow in the footsteps of certain European countries and either create vaccine passports or adopt other digital technologies that are more credible (and harder to forge) than the current vaccination cards.
But in a grander sense, vaccine mandates open up a larger discussion about public health. Tan pointed out that the success of the COVID-19 mandates could lead to mandates for other diseases. Should food workers, for instance, be vaccinated against diseases in situations with high transmission risk?
“What we’re going to ask in the future is, ‘When do we exert this idea of mandates? What are the parameters where they can work?’” Tan said. “It may turn out that the only time we find it acceptable to mandate vaccinations – aside from healthcare workers, where there’s a moral imperative – is during a pandemic. We need to be having that public health discussion.”
Until then, Tan remains convinced that widespread vaccination is our way out of the pandemic.
“Successfully implementing vaccination, either through the Biden administration’s policy or through the private sector doing what they should do, is our way out of this,” he said.